Salvati E A, Cornell C N
Instr Course Lect. 1988;37:67-73.
Long-term studies show that patients with osteonecrosis who undergo total hip replacement experience an overall failure rate four times greater than those with osteoarthritis. Different etiologic factors associated with osteonecrosis appear to carry different prognoses for the durability of total hip replacements. Important factors, in addition to discouraging total hip replacement in patients under 30 to 40 years of age and making all possible efforts to decrease the patient's weight and activity level, include improvements in bone quality, surgical and cementing techniques, prosthetic design, and materials that will prolong the durability of total hip replacements. Despite the inferior long-term results of total hip replacement performed for advanced osteonecrosis, we feel the procedure should not be abandoned for patients in their fifth decade of life or older because it provides a painless, functional hip more consistently than does any other form of arthroplasty. These patients should be informed about the importance of protecting the hip replacement by avoiding strenuous activities, impact, and obesity, and about the possibilities of future mechanical failure that may require revision surgery. Although significant improvements have been made in regard to the technology of total hip replacement, future research in the bone biology of osteonecrosis is necessary.
长期研究表明，接受全髋关节置换术的骨坏死患者的总体失败率比骨关节炎患者高四倍。与骨坏死相关的不同病因似乎对全髋关节置换术的耐用性有着不同的预后。除了不鼓励30至40岁以下的患者进行全髋关节置换术以及尽一切可能降低患者的体重和活动水平外，重要的因素还包括改善骨质、手术和骨水泥技术、假体设计以及能延长全髋关节置换术耐用性的材料。尽管晚期骨坏死患者接受全髋关节置换术的长期效果较差，但我们认为对于50岁及以上的患者，该手术不应被放弃，因为与其他任何形式的关节成形术相比，它能更持续地提供无痛、功能良好的髋关节。应告知这些患者通过避免剧烈活动、撞击和肥胖来保护髋关节置换物的重要性，以及未来可能需要翻修手术的机械故障可能性。尽管全髋关节置换技术已取得显著进步，但对骨坏死骨生物学的未来研究仍很有必要。
